Now Seaton and Honiton hospital beds are closed, here’s something to look forward to

Better keep fingers crossed that you or your loved ones are not in a similar position to some of the people mentioned here.

But if you are one of the unfortunate ones, remember Paul Diviani (EDDC), Sarah Randall Johnson (DCC), Neil Parish MP, Hugo Swire MP, Minister Jeremy Hunt and Prime Minister Theresa May all put you there. They all have one thing in common: they are Conservative politicians whose decisions led to this situation – and think carefully about whether you would vote for them now or in the future knowing what you know now.

“People who receive care at home have told a health watchdog that a lacklustre service has meant they have had to go two weeks without a shower, eat their dinner at 3.30 in the afternoon and be cared for by workers who can’t make a bed.

The failings highlighted in a report by Healthwatch England drew on the experiences of more than 3,000 people who receive care at home. Other problems described in the document include care workers coming at different times to those scheduled, not having enough time to fulfil all their duties and some missing appointments altogether.

Across England there are more than 8,500 home care providers, collectively helping an estimated 673,000 people with tasks such as washing, cooking, dressing and taking medication. The report suggested that home care was “in a fragile state” and that care packages were being “designed to meet the needs of the service provider rather than the service user”.

One home care user in Redcar and Cleveland said: “Sometimes they give me a shower but they go over their time. Most of the time they haven’t got the time to give me one so I go a couple of weeks without one and that is not right. I feel dirty.”

A woman in her 80s told Healthwatch Bradford her care workers were unable to boil an egg or make the bed, while another said staff needed to be taught “home care common sense”.

A care user in Barnet, north London, said: “I am diabetic and sometimes carers are late or don’t show up and that really affects my medications and insulin administration.”

However, Healthwatch, the health and care consumer champion, stressed that most people had positive things to say about their domiciliary care – with many older people praising the service because it enables them to remain in their own home and to maintain as much independence as possible.

Neil Tester, the deputy director of Healthwatch England, said: “We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards. Given the challenges facing the social care sector, it is more important than ever that people’s voices are heard.”

Izzi Seccombe, the chairwoman of the Local Government Association’s community wellbeing board, said: “This report shows that while most people report that their services are good there is a need to improve services.

“The financial pressure facing services is having an impact and even the very best efforts of councils are not enough to avert the real and growing crisis we are facing in ensuring older people receive the care they deserve.

“The continuing underfunding of adult social care, the significant pressures of an ageing population and the ‘national living wage’ are combining to heap pressure on the home care provider market.”

She added: “This study shows the strain providers are under, and emphasises the urgent need for a long-term, sustainable solution to the social care funding crisis.

“While the £2bn announced in the spring budget for social care was a step in the right direction, it is only one-off funding and social care services still face an annual £2.3bn funding gap by 2020.”

A Department of Health spokesman said: “Everyone deserves access to high-quality care, including those who receive it in their home. This is why we have introduced tougher inspections of care services to drive up standards, provided an additional £2bn for adult social care, and have committed to consult on the future of social care to ensure sustainability in the long term.”

2. There is IMO little hope of adequate monitoring of home care. When care is centralised in hospitals or care homes, it is easy to monitor – managers are on-hand and can monitor their own staff, and a single visit by the CQC can assess their standards. Yet despite this, there are no shortage of stories about appalling standards of care and even abuses in hospitals and care homes. So what chance is there that standards of home care will be properly monitored?

The CCG has failed to provide clinical evidence that shows that “hospital at home” is either effective or safe. Their business case includes fully loaded costs for “hospital at hospital”, but only direct staff costs (and no equipment costs or travel costs or monitoring costs) for “hospital at home”. In other words, this is a gamble, and a huge one at that. They promised that there would be a proper formal gateway review to confirm that they are ready for HaH, but that has already happened in timescales that seem so impossibly short that you have to worry about how ready they can really be.

The bottom line is that there is a big risk of “hospital at home” failing spectacularly, with people suffering badly from lack of care and a very significant risk of deaths. Jeremy “Thick” Hunt has admitted that there are already c. 8,000 avoidable deaths per year in hospitals as a result of the current crisis – and those do not count deaths due to ambulances not reaching patients in the required timescales or because there is a queue of ambulances outside A&E. It is easy to imagine that when “hospital at home” is implemented across the UK there could easily be 10x or even 100x as many avoidable deaths.